This study of 533 vascular access sites for long-term hemodialysis in patients with end-stage renal disease, accumulating more than 12,000 patient months, indicated that primary arteriovenous fistula (AVF) is the procedure of choice. The group receiving primary AVF had the greatest duration of patency: 84% at three years compared to 70% for the group receiving polytetrafluoroethylene (PTFE) grafts and less than 50% for those receiving bovine carotid artery heterografts (BCAH). Furthermore, the primary AVF group had fewer complications (25 complications in 273 fistulas) than either the BCAH group (61 in 58 grafts) or the PTFE group (171 in 202 grafts). No complication resulted in death in the primary AVF group, but seven deaths resulted from complications of the access in the graft groups, further solidifying the position of the primary AVF as the procedure of choice for chronic hemodialysis access.